Mindstorm: Simulating psychosis

The scene begins with sunshine, a steaming cup of coffee, and the morning paper. But as the psychotic episode triggers, the room darkens and voices begin to argue with each other. The telephone rings, but the caller cannot be heard clearly. The news anchorman and weatherman on TV report that you are lazy, stupid, worthless.

A knock on the door interrupts the scene, but the voices warn you to not open the door.

The pizza deliveryman hands you the square box, whose lettering changes from “pizza” to “poizzon.” The food gurgles and hisses menacingly on the countertop while exuding a putrid stench.

This is part of the latest version of “A Virtual Hallucination: Mindstorm,” a multisensory film designed to simulate a psychotic event in 3-D. Janssen, LP, a mental health pharmaceutical division of Johnson & Johnson, developed the system after five years of research on actual patient cases.

A far cry from Janssen's older, handheld models, this version offers a vastly different experience. Introduced in May at the American Psychiatric Association annual meeting, the new Mindstorm system is such a powerfully realistic sensory experience that it comes with a safety disclaimer. Unlike Janssen's earlier models (audiovisual only), the new version of Mindstorm takes place in full 3-D within an 11-seat virtual-reality theater designed by Impact Unlimited, a branding communication and exhibit design firm in Dayton, New Jersey.

Much like an IMAX theater film, Mindstorm depicts the scenes from a first-person viewpoint: The watcher is the main character. The high-tech format and polarized goggles allow viewers to experience the full multisensory effects and distorted perceptions of a psychotic event—including sights, sounds, breezes, and disturbing smells.

Although today's technologies have enabled Janssen to offer a simulation that is more “real” than was ever possible, the Mindstorm concept always has been to increase awareness of what it might be like to experience a psychotic event, says Gahan Pandina, PhD, a clinical psychologist and the director of clinical development at Johnson & Johnson Pharmaceutical Research and Development.

“Better understanding can destigmatize what it's like to have these symptoms, and can change people's current picture of mental illness,” he says. “In order to appreciate how important it is to develop new and better treatments, we have to understand the impact these symptoms can have on patients.”

The Mindstorm scenarios always have been based on routine situations—riding the bus, shopping at a pharmacy, receiving a pizza delivery—to portray the difficulties that can arise while focusing on daily tasks, complying with doctors' instructions, or interacting with others. “To patients with schizophrenia, the average day can be a very overwhelming and scary experience,” Dr. Pandina says.

Ken Duckworth, MD, medical director for the National Alliance on Mental Illness (NAMI) and a 20-year practician, notes that Mindstorm can give professional trainees a unique glimpse into the personal picture of a psychotic episode. “It's a really powerful way of showing that a person's reality is consistent with what he believes, and that people will interpret their stimuli consistent with their experience,” he explains. “If you're experiencing paranoia and hearing voices, you can start to misinterpret the other data around you.” For example, that may include the wording on a pizza box or written instructions for medication compliance, he adds.

Dr. Duckworth, who also teaches at the Boston University School of Public Health, says he hopes that this simulation technology might soon be used in the medical/public health academic setting: “One of the pieces that's so difficult to explain is how cognitively limited patients are when they're in that state [of psychosis]. They can't think logically, so it's difficult for them to follow a sequence or even to order basic tasks.”

Dr. Pandina notes that the symptoms depicted in Mindstorm's scenarios are composites and are not meant to diagnose or define psychosis. Nor are the depicted symptoms restricted to schizophrenia, since other types of mental illness, such as bipolar disorder, also can include occasional psychotic events.

Although Janssen markets antipsychotic pharmaceuticals, the Mindstorm presentation does not include any mention of specific drugs or treatments. “In the scenario, someone may say, ‘Did you take your medication today?’ but there are no specific drugs mentioned,” Dr. Pandina says. “But Mindstorm does impart that people who have serious mental illnesses need help in managing their own treatments and their wellness.”

Mindstorm also emphasizes the crucial role that caregivers and family helpers play in helping to maintain a patient's wellness, Dr. Pandina says: “[In the scenario] the patient begins to break away from his focus on his symptoms once the person who helps enters the scene.”

According to 2006 data from the National Institute of Mental Health, approximately 2.4 million U.S. adults have been diagnosed with schizophrenia. For people who have never experienced a psychotic event, gaining an understanding of the distorted reality involved in psychosis can be a hurdle. It's no surprise that Janssen's handheld simulation units have been used for years as awareness-training tools by law enforcement, emergency services, and crisis intervention teams across the country.

People who have a family member who experiences phases of distorted reality also may struggle with their own frustrations, wondering, “Why can't he just get over it?” or “Why can't she just ignore the voices?” Dr. Duckworth explains. Experiencing a 3-D simulation like Mindstorm could show families a rendition of what their loved one may be experiencing, perhaps leading to greater understanding and better support from the extended family unit, he notes.

Bob Carolla, media relations director at NAMI, says the bus-ride scenario he viewed recently on a Janssen handheld unit definitely reflected his own personal experience with a hallucination episode related to his bipolar disorder. He emphasizes the simulation's accuracy and realism: “It demonstrates the confusion and difficulty in concentration that affect a person,” he says. “The machine accurately shows how the ‘real’ can change to the ‘unreal’ and back again without a person knowing what is actually real.”

But Carolla still wonders if people who have never experienced a psychotic event firsthand may think Mindstorm's multisensory depictions are too wild to be true. “Some may think it's too contrived or exaggerated or too fantastic to be believed,” he says. “Well, believe it. The experience is real.”

Janssen already is working on ways to make the 3-D theater version of Mindstorm more portable, possibly as a mobile-van format. Meanwhile, Janssen will be demonstrating the full Mindstorm theater at several conferences and meetings, including this month's U.S. Psychiatric and Mental Health Congress.